Signs and Symptoms of Lupus

Lupus is a very variable condition. While it has many characteristic symptoms, most patients will never experience all of them. Similarly, no two patients experience identical symptoms.

The severity of the disease also varies. In some patients symptoms appear suddenly and are relatively severe, while in others the disease remains at a low level for several years before diagnosis. For most patients, however, the frightening descriptions of life-threatening disease in medical textbooks never occur, and the condition remains mild and readily manageable.

Lupus runs an unpredictable course. For some people, symptoms subside after treatment of the initial acute attack. For others, periods of “remission” are punctuated by brief “flare-ups” of disease.

Initial symptoms

Several symptoms may be seen in the initial stages of lupus. These include:

Fatigue, weakness and lethargy

Joint pain or swelling (experienced by about half of patients)

Skin rashes (around one in five patients)

Fever

Download the ‘Anatomy of Lupus’ mini-poster below.

How does lupus affect the body?

Lupus can affect many parts of the body. In fact, lupus (or SLE) can affect every part of the body from skin, to blood cells to organs. Most patients experience fatigue, tiredness and weakness. Some of the other most common symptoms of lupus are described below.

Skin

Almost any type of skin rash may occur with lupus, affecting around two-thirds of patients. The characteristic lupus “butterfly” rash of the cheeks and nose is seen in about one-third of patients, while one in five patients experience mouth sores. Hives and altered skin colour (a lightening or darkening of the skin in places) can also occur. One-third of patients experience Raynaud’s phenomenon, where their fingers turn white then bluish on exposure to stress, cold or vibration.

Joints

Joint pain (also known as arthralgia) and inflammation (arthritis) are common features of lupus. Nine out of 10 patients experience some form of joint pain, most commonly occurring in the hands, wrists and feet. Joint pain – which is often accompanied by stiffness and/or swelling – is most severe in the morning and eases later in the day.

Hair

During active disease, significant hair loss, or alopecia, can occur. Usually the loss is only temporary and can be treated with a variety of remedies. Certain lupus medications, such as anti-malarial drugs and corticosteroids, may encourage hair growth.

Tendons

When tendons are inflamed, they can tighten, causing fingers to pull into abnormal positions such as “trigger fingers”. This is, however, an unusual problem.

Muscles

Muscle ache, known technically as myalgia, may occur in up to two-thirds of patients. The muscles between the elbow and neck, the knee and hip are most frequently involved. Muscle inflammation or swelling is less common, but requires treatment, as unlike myalgia, it can lead to permanent muscle weakness.

Lungs

A thin lining called the pleura surrounds the lungs. Inflammation of this lining is called pleuritis, a condition that affects around one-half of lupus patients at some stage during their life. This causes chest pain when deep breaths are taken.

Heart

Inflammation of the sac surrounding the heart, the pericardium, is called pericarditis and affects about a quarter of those with lupus. The main symptom of pericarditis is chest pain below the breastbone that is often relieved by bending forward. 1

Kidneys

A condition called lupus nephritis sometimes develops when the delicate filtering mechanisms of the kidney, the nephrons, become inflamed.

Blood

Lupus can affect the cells of the blood system and the components of the system that are involved in blood clotting. The most common complaint is anaemia, or too few red blood cells in the bloodstream. As red blood cells carry oxygen to tissues, patients with anaemia will often feel tired. Drops in the levels of white blood cells (defenders against infection) and platelets (which help the blood to clot) are also seen in some patients.

Immune System

A condition known as lymphadenopathy, or swollen lymph nodes (most people know lymph nodes as “glands”) can sometimes occur.

Brain and Nervous System

Inflammation of the blood vessels of the brain can cause a variety of symptoms, including depression, seizures and visual disturbances.